Can We Learn in the Sandbox Together?: Interprofessional Case Conferences as Facilitation Tools

Duke Medicine utilized interprofessional case conferences (ICCs) from 2008-2012 with the objective of modeling and facilitating development of teamwork skills among diverse health profession students, including physical therapy, physician assistant, medical doctor and nursing. The purpose of this publication was to describe the operational process used to develop and implement the ICCs and measure the success of the ICCs in order to shape future work. The ICCs were offered to develop skills and attitudes essential for participation in healthcare teams. Students were facilitated by faculty of different professions to conduct a comprehensive historical assessment of a standardized patient (SP), determine pertinent physical and lab assessments to undertake, and develop and share a comprehensive management plan. Cases included patient problems that were authentic and relevant to each professional student in attendance. The main barriers to implementation are outlined and the focus on the process of working together is highlighted. Evaluation showed high satisfaction rates among participants and the outcomes from these experiences are presented. The limitations of these results are discussed and recommendations for future assessment are emphasized. The ICCs demonstrated that students will come together voluntarily to learn in teams, even at a research-focused institution, and express benefit from the collaborative exercise.

Phase II Archaeological Excavations at 99 Main Street, 18AP21 (Sign of the Whale), Annapolis, Maryland

Historical Annapolis Foundation (HAF) conducted terrestrial archaeological investigations at site 18AP21 in the city of Annapolis, Maryland. Excavations were carried out at this National Register site ostensibly as a Phase II project to evaluate the site and assess the need for further work. The site is at 99 Main Street in the center of downtown Annapolis, near the Annapolis waterfront. The project was carried out as part of the advanced work for the Annapolis History Center project, to be built in the adjoining buildings of 99 Main and 196 Green Streets. The buildings are the property of the Historic Annapolis Foundation and located in Maryland Research Unit 7. The excavations were undertaken by HAF, and funded by HAFF. The work was conducted for HAF and MHT, who holds an archaeological easement on the property. This preliminary phase of work included stratigraphic excavation of two testpit units. These two units revealed that the site of the existing 99 Main Street building was the location of three previous constructions. The current building at 99 Main Street, built in 1791, was preceded by an earlier brick dwelling, evidenced by a stout pier of bricks, which was attached to a wooden-sided structure that stood on a foundation of brick and stone. Ceramics indicate that these buildings date to the early-middle of the 18th century. A third structure of post-in-ground construction, evidenced by recovery of burned posts and wood fragments, likely existed prior to these, but evidence was scant. These excavations reveal that the site of 18AP21 holds potential for understanding Annapolis's early cultural developments, especially in the area of initial settlement and the origins of waterfront commerce. The assemblage of artifacts recovered includes a broad sample of common 18th century pottery such as creamware and Chinese export porcelain, and also includes some early colonial types such as tin-glazed earthenware and various red-bodied slipwares. The excavations do not provide conclusive evidence of the construction sequence. Consultation with MHT representatives indicates that further work at the site will likely be needed before modifications to the floor of the building can progress.

HIV-1 envelope gp41 antibodies can originate from terminal ileum B cells that share cross-reactivity with commensal bacteria.

Monoclonal antibodies derived from blood plasma cells of acute HIV-1-infected individuals are predominantly targeted to the HIV Env gp41 and cross-reactive with commensal bacteria. To understand this phenomenon, we examined anti-HIV responses in ileum B cells using recombinant antibody technology and probed their relationship to commensal bacteria. The dominant ileum B cell response was to Env gp41. Remarkably, a majority (82%) of the ileum anti-gp41 antibodies cross-reacted with commensal bacteria, and of those, 43% showed non-HIV-1 antigen polyreactivity. Pyrosequencing revealed shared HIV-1 antibody clonal lineages between ileum and blood. Mutated immunoglobulin G antibodies cross-reactive with both Env gp41 and microbiota could also be isolated from the ileum of HIV-1 uninfected individuals. Thus, the gp41 commensal bacterial antigen cross-reactive antibodies originate in the intestine, and the gp41 Env response in HIV-1 infection can be derived from a preinfection memory B cell pool triggered by commensal bacteria that cross-react with Env.

Can Genetics Predict Response to Complex Behavioral Interventions? Evidence from a Genetic Analysis of the Fast Track Randomized Control Trial.

Early interventions are a preferred method for addressing behavioral problems in high-risk children, but often have only modest effects. Identifying sources of variation in intervention effects can suggest means to improve efficiency. One potential source of such variation is the genome. We conducted a genetic analysis of the Fast Track randomized control trial, a 10-year-long intervention to prevent high-risk kindergarteners from developing adult externalizing problems including substance abuse and antisocial behavior. We tested whether variants of the glucocorticoid receptor gene NR3C1 were associated with differences in response to the Fast Track intervention. We found that in European-American children, a variant of NR3C1 identified by the single-nucleotide polymorphism rs10482672 was associated with increased risk for externalizing psychopathology in control group children and decreased risk for externalizing psychopathology in intervention group children. Variation in NR3C1 measured in this study was not associated with differential intervention response in African-American children. We discuss implications for efforts to prevent externalizing problems in high-risk children and for public policy in the genomic era.

I can see it both ways: first- and third-person visual perspectives at retrieval.

The number of studies examining visual perspective during retrieval has recently grown. However, the way in which perspective has been conceptualized differs across studies. Some studies have suggested perspective is experienced as either a first-person or a third-person perspective, whereas others have suggested both perspectives can be experienced during a single retrieval attempt. This aspect of perspective was examined across three studies, which used different measurement techniques commonly used in studies of perspective. Results suggest that individuals can experience more than one perspective when recalling events. Furthermore, the experience of the two perspectives correlated differentially with ratings of vividness, suggesting that the two perspectives should not be considered in opposition of one another. We also found evidence of a gender effect in the experience of perspective, with females experiencing third-person perspectives more often than males. Future studies should allow for the experience of more than one perspective during retrieval.

Puzzling thoughts for H. M.: can new semantic information be anchored to old semantic memories?

Researchers currently debate whether new semantic knowledge can be learned and retrieved despite extensive damage to medial temporal lobe (MTL) structures. The authors explored whether H. M., a patient with amnesia, could acquire new semantic information in the context of his lifelong hobby of solving crossword puzzles. First, H. M. was tested on a series of word-skills tests believed important in solving crosswords. He also completed 3 new crosswords: 1 puzzle testing pre-1953 knowledge, another testing post-1953 knowledge, and another combining the 2 by giving postoperative semantic clues for preoperative answers. From the results, the authors concluded that H. M. can acquire new semantic knowledge, at least temporarily, when he can anchor it to mental representations established preoperatively.

Facilitation shifts paradigms and can amplify coastal Restoration efforts

Restoration has been elevated as an important strategy to reverse the decline of coastal wetlands worldwide. Current practice in restoration science emphasizes minimizing competition between outplanted propagules to maximize planting success. This paradigm persists despite the fact that foundational theory in ecology demonstrates that positive species interactions are key to organism success under high physical stress, such as recolonization of bare substrate. As evidence of how entrenched this restoration paradigm is, our survey of 25 restoration organizations in 14 states in the United States revealed that >95% of these agencies assume minimizing negative interactions (i.e., competition) between outplants will maximize propagule growth. Restoration experiments in both Western and Eastern Atlantic salt marshes demonstrate, however, that a simple change in planting configuration (placing propagules next to, rather than at a distance from, each other) results in harnessing facilitation and increased yields by 107% on average. Thus, small adjustments in restoration design may catalyze untapped positive species interactions, resulting in significantly higher restoration success with no added cost. As positive interactions between organisms commonly occur in coastal ecosystems (especially in more physically stressful areas like uncolonized substrate) and conservation resources are limited, transformation of the coastal restoration paradigm to incorporate facilitation theory may enhance conservation efforts, shoreline defense, and provisioning of ecosystem services such as fisheries production.

Can Cooling Technology Save Many-Core Parallel Programming from Its Programming Woes?

An abstract of this work will be presented at the Compiler, Architecture and Tools Conference (CATC), Intel Development Center, Haifa, Israel November 23, 2015.

International guidelines for management of metastatic breast cancer: Can metastatic breast cancer be cured?

A distinctive subset of metastatic breast cancer (MBC) is oligometastatic disease, which is characterized by single or few detectable metastatic lesions. The existing treatment guidelines for patients with localized MBC include surgery, radiotherapy, and regional chemotherapy. The European School of Oncology-Metastatic Breast Cancer Task Force addressed the management of these patients in its first consensus recommendations published in 2007. The Task Force endorsed the possibility of a more aggressive and multidisciplinary approach for patients with oligometastatic disease, stressing also the need for clinical trials in this patient population. At the sixth European Breast Cancer Conference, held in Berlin in March 2008, the second public session on MBC guidelines addressed the controversial issue of whether MBC can be cured. In this commentary, we summarize the discussion and related recommendations regarding the available therapeutic options that are possibly associated with cure in these patients. In particular, data on local (surgery and radiotherapy) and chemotherapy options are discussed. Large retrospective series show an association between surgical removal of the primary tumor or of lung metastases and improved long-term outcome in patients with oligometastatic disease. In the absence of data from prospective randomized studies, removal of the primary tumor or isolated metastatic lesions may be an attractive therapeutic strategy in this subset of patients, offering rapid disease control and potential for survival benefit. Some improvement in outcome may also be achieved with optimization of systemic therapies, possibly in combination with optimal local treatment. © 2010. Published by Oxford University Press.

How a different look at latency can help to develop novel diagnostics and vaccines against tuberculosis.

Mycobacterium tuberculosis is one of the most successful human pathogens. It kills every year approximately 1.5 - 2 million people, and at present a third of the human population is estimated to be infected. Fortunately, only a relatively small proportion of the infected individuals will progress to active disease, and most will maintain a latent infection. Although a latent infection is clinically silent and not contagious, it can reactivate to cause highly contagious pulmonary tuberculosis, the most prevalent form of the disease in adults. Therefore, a thorough understanding of latency and reactivation may help to develop novel control strategies against tuberculosis. The most widely held view is that the mycobacteria are imprisoned in granulomatous structures during latency, where they can survive in a non-replicating, dormant form until reactivation occurs. However, there is no hard data to sustain that the reactivating mycobacteria are indeed those that laid dormant within the granulomas. In this review an alternative model, based on evidence from early studies, as well as recent reports is presented, in which the latent mycobacteria reside outside granulomas, within non-macrophage cell types throughout the infected body. Potential implications for new diagnostic and vaccine design are discussed.

Can hypermedia aided learning (HAL) deliver?

This paper presents the results of a research project aimed at evaluating (HAL) as a mode of course delivery. More specifically the paper will deal with: • Developing a hypermedia courseware for students studying research methods; and • Evaluating hypermedia courseware as a method of delivery against traditional methods. This paper concentrates on pedagogical issues regarding computer aided learning and reports that this research gives tentative indications that hypermedia based learning (either through CD-ROM or the, as means of course delivery could be as effective as traditional modes of course delivery.

Innovations in learning and teaching approaches using game technologies - can "The Movies" teach how to make a movie?

The use of games technology in education is not a new phenomenon. Even back in the days of 286 processors, PCs were used in some schools along with (what looks like now) primitive simulation software to teach a range of different skills and techniques – from basic programming using Logo (the turtle style car with a pen at the back that could be used to draw on the floor – always a good way of attracting the attention of school kids!) up to quite sophisticated replications of physical problems, such as working out the trajectory of a missile to blow up an enemies’ tank. So why are games not more widely used in education (especially in FE and HE)? Can they help to support learners even at this advanced stage in their education? We aim to provide in this article an overview of the use of game technologies in education (almost as a small literature review for interested parties) and then go more in depth into one particular example we aim to introduce from this coming academic year (Sept. 2006) to help with teaching and assessment of one area of our Multimedia curriculum. Of course, we will not be able to fully provide the reader with data on how successful this is but we will be running a blog (http://themoviesineducation.blogspot.com/) to keep interested parties up to date with the progress of the project and to hopefully help others to set up similar solutions themselves. We will also only consider a small element of the implementation here and cover how the use of such assessment processes could be used in a broader context. The use of a game to aid learning and improve achievement is suggested because traditional methods of engagement are currently failing on some levels. By this it is meant that various parts of the production process we normally cover in our Multimedia degree are becoming difficult to monitor and continually assess.